Provider Demographics
NPI:1982103362
Name:PRIMECARE ON WIXOM PLLC
Entity Type:Organization
Organization Name:PRIMECARE ON WIXOM PLLC
Other - Org Name:PRIMECARE ON WIXOM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAID
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-426-7200
Mailing Address - Street 1:39555 W 10 MILE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27250 WIXOM RD STE A
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1116
Practice Address - Country:US
Practice Address - Phone:248-426-7200
Practice Address - Fax:248-426-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty